Lecture 20: cerebellar dysfunction II - physical therapy examination for cerebellar dysfunction

observations to note about postural sway/titubation

note any rhythmic tremors of the head or trunk

observations to note about movement initiation

is there a delay or struggle to begin a task

observations to note about speed & accuracy

are movements slow, guarded, or overshooting the intended target

observations to note about extraneous movements

look for associated movements (facial grimacing, unnecessary limb mirroring)

cerebellar ataxia - primary problem

timing, scaling, coordination

cerebellar ataxia - gait

wide BOS, unsteady, staggering

cerebellar ataxia - vision dependence

minimal

cerebellar ataxia - romberg test

negative or mildly positive

cerebellar ataxia - coordination

dysmetria, dysdiadochokinesia

cerebellar ataxia - balance

poor in all conditions

cerebellar ataxia - eye exam

nystagmus, impaired smooth pursuit

cerebellar ataxia - speech

dysarthria, scanning speech

cerebellar ataxia - effect of practice

limited carryover, needs repetition

sensory ataxia - primary problem

loss of proprioception

sensory ataxia - gait

stomping gait, worse in dark

sensory ataxia - vision dependence

high (worse with eyes closed)

sensory ataxia - romberg test

positive

sensory ataxia - coordination

relatively intact if vision is allowed

sensory ataxia - balance

worse without visual input

sensory ataxia - eye exam

typically normal

sensory ataxia - speech

normal

sensory ataxia - effect of practice

improves with visual cues

vestibular ataxia - primary problem

impaired balance and gaze control

vestibular ataxia - gait

veers to one side

vestibular ataxia - vision dependence

moderate

vestibular ataxia - romberg test

may be positive

vestibular ataxia - coordination

usually intact

vestibular ataxia - balance

poor, especially with head movements

vestibular ataxia - eye exam

prominent nystagmus, VOR deficits

vestibular ataxia - speech

normal

vestibular ataxia - effect of practice

improves with compensation strategies

intralimb coordination

movements within a single limb (brushing hair with one hand, leg swing during gait)

interlimb (bimanual) coordination

integrated performance of two or more limbs working together (dressing, transfers, coordination between legs with walking)

visual motor coordination

integrating visual and motor abilities to accomplish a goal (tracing a line, driving, eye-head-hand coordination for reaching)

common findings when observing functional movement

overshooting/undershooting (dysmetria), irregular movement patterns, loss of fluidity

what to identify during patient centered assessment

the most difficult and easily performed tasks

what to focus on during patient centered assessment

the highest functional level and meaningful ADLs

what is the highest functional level

the most demanding posture the patient can achieve + the most complex task they can perform in that position (safely)

gait characteristics

ataxic, variable step length, poor coordination, increased BOS

outcome measure for ataxia severity

SARA or ICARS

outcome measure for balance

miniBEST

outcome measure for mobility

TUG, 10MWT, 6MWT

functional tasks for UE coordination

reach and grasp, object manipulation, ADLs